Objective
To perform a European survey of the evidence needs and training demands of insurance medicine professionals related to professional tasks and evidence-based practice.
Design
International survey.
Subjects
Professionals working in insurance medicine.
Methods
Experts designed an online questionnaire including 26 questions related to 4 themes: evidence needs; training demands; evidence-seeking behaviour; and attitudes towards evidence-based medicine. Descriptive statistics were presented by country/conference and the total sample.
Results
A total of 782 participants responded. Three-quarter of participants experienced evidence needs at least once a week, related to mental disorders (79%), musculoskeletal disorders (67%) and occupational health (65%). Guidelines (76%) and systematic reviews (60%) were the preferred types of evidence and were requested for assessment of work capacity (64%) and prognosis of return-to-work (51%). Evidence-based medicine was thought to facilitate decision-making in insurance medicine (95%). Fifty-two percent of participants felt comfortable finding, reading, interpreting, and applying evidence. Countries expressed similar needs for reviews on typical topics.
Conclusion
This study reveals evidence gaps in key areas of insurance medicine, supporting the need for further research, guidelines and training in evidence-based insurance medicine. Importantly, insurance medicine professionals should recognize that evidence-based practice is crucial in producing high-quality assessments.
LAY ABSTRACT
Evidence-based medicine (EBM) means the consideration of research findings when taking decisions in clinical medicine. This approach has become standard in health and social care. Since it is less clear to what degree EBM is applied in insurance medicine, European insurance physicians performed a joint survey among colleagues in 8 countries and 2 conferences. More than 700 professionals participated. Half of respondents experienced a need at least once a week to look for guidelines and systematic reviews about work capacity assessments related to mental or musculoskeletal disorders. Almost all thought that EBM would facilitate decision-making. Not all felt competent in finding, reading, interpreting, and applying research evidence. Overall, findings were similar across countries. These results illustrate important evidence gaps in insurance medicine, supporting the need for further research and guidelines. Importantly, professionals should recognize that evidence-based practice is crucial in producing high-quality assessments.
Infections with the nematode N. brasiliensis is associated with a recruitment of intestinal mucosal mast cells (MMC) which increase greatly in numbers. We have studied histamine levels in the gut, whole blood and plasma in relation to MMC of the gut and blood cell morphology during the course of the infection in an attempt to clarify possible relations between circulating blood basophils and MMC. The results show a parallel increase in MMC numbers and histamine content of the gut, remaining high to day 20 after infection. Blood histamine increased from a control level of 30-40 ng/ml to a maximum of 200 ng/ml on day 12 to 14, but returned towards the control level already on day 16 after infection. There was a corresponding increase in plasma histamine to a maximum of 80 ng/ml. The total number of blood neutrophils increased during the early phase of the infection and there was a pronounced eosinophilia from day 10 to 16. No cells containing metachromatic granules were found in a screening comprised of 10,000 cells per specimen. During day 10 to 16 we found a number of coarsely granuled and vacuolated cells. The granules stained darkly by the Giemsa stain but not metachromatically with Toluidine Blue or with Alcian Blue at a low pH. We interpret this as an equivalent to the so-called toxic granulation occurring in human neutrophils. These cells may have been mistaken for basophils by previous investigators. The cellular repository for the high concentration of histamine in the blood is unknown. We suggest, as a working hypothesis, that it is contained in a circulating progenitor for MMC which has the ability to synthesize and, in a loosely bound state store, histamine, but which has not yet acquired the ability to assemble the specific metachromatic granules.
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